The AIDS/HIV Integrated Model District Programme. Annual Report Program Year 2. July 2002 June 2003

Transcription

1 The AIDS/HIV Integrated Model District Programme Annual Report Program Year 2 July 2002 June 2003 AIM is a USAID and CDC Funded Project Implemented by JSI Research and Training Institute, Inc. with World Education, Inc. and World Learning The AIDS/HIV Model District Programme First Floor Nakawa House Plot 3-7 Port Bell Road P.O. Box 12009, Kampala, Uganda info@aimuganda.org Phone: /19 Fax:

2 TABLE OF CONTENTS List of Acronyms iii Executive Summary 1 Section 1: District Level Activities and Achievements HIV/AIDS Needs Assessments and Strategic Plans Building Capacity of District Coordination Structures Phase I District Launches Phase II Districts Security Issues and Work in Conflict Areas 7 Section 2: Activities and Achievements at National Level Joint Institutional Assessments Support to National TB Program Policy and Guideline Development 10 Section 3: Progress towards AIM Program Objectives Progress towards Objective 1 (Foundational and Capacity Building) Progress towards Objective 2 (Referral Network, IEC) Progress towards Objective 3 (VCT, PMTCT, STI, TPP) Progress towards Objective 4 (OI, IC, TB, Laboratory Capacity) Progress towards Objective 5 (OVC, Adolescents, HBC, PLWA) 18 Section 4: Grants Implementation Strategy and Implementation Exceptional Cases 23 Section 5: Program Management and Planning Planning for PY Monitoring and Evaluation/Quality Assurance Information, Communication and External Relations Organizational Restructuring and Strengthening Finance and Administration 30 Section 6: The Year Ahead 31 i

3 Annexes: I. Milestone Indicators: Progress through June, II. Organization Chart (draft) 33 III. Key Achievements 34 IV. Grants Summary 35 V. Training Summary 38 VI. Program Emphasis over Life of Project 39 ii

4 LIST OF ACRONYMS ACP AIC AIDS AIM ART ARV AVSI ASO BCC CA CB CHBC CBOs CDC CDFU CTT DAT DDHS DHAC DHS DOPs DOTS DRI DTLS EGPAF FBOs GOU HBC HIV IC AIDS Control Programme of the MOH AIDS Information Centre Acquired Immunodeficiency Syndrome AIDS/HIV Integrated District Programme Anti-retroviral therapy Anti-Retroviral Association Voluntary Service International AIDS Service Organization Behaviour Change Communication Cooperative Agreement Capacity Building Community and home based care Community Based Organizations Centers for Disease Control and Prevention Communication for Development Foundation Uganda Central Training Team District AIDS Task Force District Director for Health Services District HIV/AIDS Committee Demographic and Health Survey District Operations Directly Observed Treatment, Short course (TB) District Response Initiative District TB & Leprosy Supervisor Elizabeth Glaser Paediatric AIDS Foundation Faith Based Organizations Government of Uganda Home based care Human Immunodeficiency Virus Infection Control iii

5 IDP IEC IGAs IMAU ISSP JIA JSI R&T LC LRA M&E MOESC MGLSD MOH MOLG NA NAC NACWOLA NGOs NTLP OIs OVC PIASCY PLWHA PMTCT PY RC RMO SA SA/NA SDU STI Internally Displaced Persons Information Education and Communication Income Generating Activities Islamic Medical Association of Uganda Integrated Social Services Project Joint Institutional Assessment JSI Research and Training Local Councils Lord s Resistance Army Monitoring and Evaluation Ministry of Education, Sports and Culture Ministry of Gender, Labour and Social Development Ministry Of Health Ministry Of Local Government Needs Assessment National AIDS Conference National Association of Women Living with AIDS Non Governmental Organizations National TB and Leprosy Programme Opportunistic Infections Orphans and Vulnerable Children Presidential Initiative on AIDS Strategy for Communication to Youth People Living With HIV and AIDS Prevention of Mother to Child Transmission Program Year Regional Coordinator (AIM) Regional Medical Officer Situational Analysis Situational Analysis/Needs Assessment Strengthening Decentralisation in Uganda Project Sexually Transmitted Infections iv

6 T&CB TA TASO TB THETA TRG TOT UAC UACP ULAA UNASO UPHOLD USAID UWESO VCT WEI WL ZTLS Training and Capacity Building Technical Assistance The AIDS Support Organisation Tuberculosis Traditional and Modern Health Practitioners Together Against AIDS and Other Diseases Training Resources Group Training of Trainers Uganda AIDS Commission Uganda AIDS Control Project Uganda Local Authorities Association Uganda Network of AIDS Service Organisations Uganda Program for Health and Holistic Development United States Agency for International Development Uganda Women s Effort to Save Orphans Voluntary Counselling and Testing World Education, Inc. World Learning Zonal TB & Leprosy Supervisor v

7 EXECUTIVE SUMMARY The focus of AIM in Program Year (PY) 2 was on laying the groundwork for rapid expansion of service delivery support in Program Year 3 (PY 3). The wide-ranging and complementary activities completed during PY 2 were essential for building the strong foundation which will allow AIM and its partners to achieve their goals. Through a strategic process of needs assessment, strategic planning, capacity building, and grants implementation, AIM is now well-positioned to work with national and district partners to support the expanded delivery of high quality HIV/AIDS and TB services in the years ahead. AIM has worked actively in Phase I districts to build the capacity of the District HIV/AIDS Committees (DHAC) to support and coordinate HIV/AIDS programs. The DHAC s were briefed on the initial results of the Situational Analysis/Needs Assessment in each district and trained on next steps they would need to take to move toward five-year strategic plans and work plans. AIM carried out trainings with the DHAC members on strategic planning, action plan development, coordination of ongoing and future activities, and the need for stakeholder consensus. Additional district level activities included the procurement of computer equipment for the DHAC offices, a laboratory assessment, and procurement plan that will provide Health Centres IV and above in each district with necessary equipment. A survey was carried out of potential NGO, CBO and FBO grantees to identify their financial management capacity in handling AIM grants and the training they would need in accountability and internal controls. Developmental activities in Phase II districts also started in PY 2. DHAC and DAT members participated in training and technical assistance activities through AIM, and a limited number of grants were awarded as well. Importantly, each Phase II district participated actively in the needs assessment exercise with AIM in the final quarter of PY 2. The results from the needs assessment will help guide the strategic planning and work planning processes that AIM will support in PY 3. AIM collaborated with the Ugandan AIDS Commission (UAC) to develop HIV/AIDS District Coordination Guidelines. These are the blueprints for districts to take ownership of activities and coordination of their overall HIV/AIDS plans. These guidelines were disseminated to districts in a conference co-sponsored by Uganda Local Authorities Association (ULAA). AIM held intensive internal and external discussions regarding its grants program. With input from USAID and others, AIM developed a grants strategy document that sets forth the program vision for granting. This vision indicates an evolving process of increasing district-level responsibility for grants solicitation, review, award, and monitoring. Further, it clarified that grants for service delivery will serve the strategic ends of fostering improved public-private partnerships while strengthening decentralized planning, co-ordination and decision-making. To support its grants initiative, AIM developed extensive tools, guidelines, formats and documentation. AIM staff and consultants have worked with the DHACs to accelerate the granting process. This has included training, technical support, supervision and documentation. The results have been impressive; through the end of June, a cumulative total of 81 grants were awarded. 1

8 At national level, AIM continued to support key policy initiatives and the development of guidelines. AIM technical advisors worked with MOH central training teams and other technical groups on policies for VCT, ART, and OVC. AIM also continued its program of institutional support for its national non-governmental partners. Key interventions included training and technical assistance in strategic planning, monitoring and evaluation and human resources management. In addition, AIM worked with the National TB and Leprosy Programme (NTLP) to develop a strategy to support future NTLP program expansion. AIM recruited experienced staff to support expanded TB activities at regional and central level. AIM started to compile national and international resource guidelines and best practices related to AIM core services. These resources will help inform the development of a toolkit to support delivery of services in the districts. Collaboration continued to be a key strategy for AIM as it worked with groups such as AIC and TASO, SDU and NTLP marking clear points where AIM and the agencies could benefit. Next steps for these partnerships will take place in the districts as crossfertilization of activities, funding and technical assistance take priority. AIM invested heavily in monitoring and evaluation during PY 2. Agreement was reached by USAID, CDC and AIM on a comprehensive set of indicators for AIM. To track program progress and facilitate reporting, AIM developed a computerized database for monitoring and evaluation. Training and technical assistance activities are tracked in the database, as are the quarterly reports from AIM s expanding list of grantees. AIM also installed and operationalized USAID s TraiNet software to record and report on AIM-funded trainees. The Monitoring and Evaluation team also oversaw data collection activities, in particular the needs assessments for Phase I and Phase II districts, provided extensive M&E training to grantees and partners, and played an active role in supporting grantee M&E efforts. AIM took advantage of the typical lull in program activities during the December/January season to move offices. Given the expansion of the program with the modification of the Cooperative Agreement (CA) and the arrival of the Integrated Social Services Project (ISSP, now called UPHOLD) it was felt that new space was needed to accommodate the growing staff and foster collaboration between the USAID-funded activities. The task of relocating staff from its established work-space took considerable effort but was rewarded as the end of December witnessed the opening of AIM s new base. The addition of six new Phase II districts, plus an added technical focus on tuberculosis, increased the pace and volume of program activity, both at national and district level. To meet the challenges of the revised CA, AIM recruited new staff and reorganized its grants management program. To ensure completion of its goals, AIM and USAID jointly drafted benchmarks in the third quarter for program performance over the coming year in a number of critical areas. These benchmarks are indicators that will allow AIM and its funders to quickly demonstrate the effect that AIM support has at district and national level. A status report on these benchmarks as at end of June 2003 was produced and is appended to this report. 2

9 The next few months will focus on ensuring that the AIM team is in the best position to meet challenges resulting from the expansion of the project. AIM, with JSI, is confident about the work and achievements accomplished to date and the direction the project is taking. The AIM annual work planning exercise, the organizational restructuring, the office move and the strengthening of collaboration with DELIVER and UPHOLD are important steps to ensure that the project is in a healthy state and a favourable position to achieve the goals it has set for Program Year 3. 3

10 Section 1: District Level Activities and Accomplishments THE AIDS/HIV INTEGRATED MODEL DISTRICT PROGRAMME - UGANDA AIM carried out an intensive program of district capacity building in PY 2, involving assessment, strategic planning, targeted training and technical assistance, and the start up of the grants program. The net effect of these activities has been to lay the ground work for expanded quantity and quality of HIV/AIDS and TB services in the districts. Indeed, this will be the focus of the final three years of the AIM Programme. 1.1 HIV/AIDS Needs Assessments and Strategic Plans AIM contracted a local firm to conduct a needs assessment exercise in the Phase I districts. Though the exercise took longer to complete than anticipated, nine district reports had been completed by the end of Copies of these reports are available in the AIM resource centre. The results from the exercise were discussed with the DHAC in each district and they formed the background for the development of the District HIV/AIDS strategic plans. Because of the security situation prevailing in northern Uganda at the time of the needs assessment, one that has continued up to this day, the needs assessment exercise could not be conducted in Pader district and in a few sub counties in Lira and Apac. The launch of the District Strategic Plan for Soroti district. In attendance are Mr. Ken Heise (AIM Assistant Director), Mr. Masiga (RDC) and Capt. J.M. Otekat (LCV). In this same program year, AIM completed the activity of supporting nine Phase I districts to develop their district-wide HIV/AIDS strategic plans. This strategic planning process, including analysis by districts of the current services available and the creation of an agreed upon plan, was critical for planning AIM s support to districts. The strategic plans allowed districts to take a comprehensive review of all the services currently available, identify gaps and establish priorities. The documents have proved extremely useful and have guided AIM and the districts, particularly in identifying, funding and supporting organizations to provide services. 1.2 Building Capacity of District Coordination Structures AIM supported the Uganda AIDS Commission (UAC) to operationalize the District HIV/AIDS coordination guidelines which were developed by UAC with the active support and involvement of AIM during the year. AIM, in collaboration with the Strengthening Decentralisation in Uganda (SDU) project, supported the training of the newly formed District AIDS Task forces (DATs) in their roles and responsibilities. Other capacity building activities for the district during the year included the training of DHACs in proposal writing and review and in leadership and management skills through workshops conducted by a combination of AIM staff, consultants and SDU. AIM also equipped 4

11 districts with computers for DHAC use and supported those districts without access to electric power with the installation of solar systems to power the computers. Regional Manager Eastern, MJ Musungu during a DAT capacity building session in Pallisa district TOTs In order to build a district-based cadre of trainers who would help in conducting district trainings in the AIM 10 core services both at the district and lower levels, a total of 105 trainers in the Phase I districts were equipped with generic training skills in three regional TOT workshops. The skills passed on to the trainers included planning, designing and delivering quality and effective training sessions. Participants in the workshops included medical officers, clinicians, health educators and program and field officers from NGOs, FBOs and CBOs from all the 10 Phase I districts. Generic TOT conducted for Phase 1 districts in Mbale Resort Hotel 5

12 1.3 Phase I District Launches Mr. Med Makumbi (AIM Assist Director) and Mr. Elemukorit (LCV) sign a partnership agreement between AIM and Katakwi district during the launch of the DSP. AIM provided extensive support for the launch of the five-year HIV/AIDS strategic plans for nine Phase I districts. The events were well-attended by district civic and political leaders as well as partner organizations in the areas of HIV/AIDS/TB. AIM was pleased that USAID and CDC representatives were able to attend some of the launches as well. Other guests included the MPs, district councillors, the heads of department of district local government, representatives of civil society organizations, and staff of UPHOLD. AIM headquarters was represented by the COP and the Assistant Directors, head office and regional staff. AIM contracted a public relations firm, VR Promotions, to provide additional support to the districts to facilitate successful launches. A drama group performing at the launch of the DSP in Soroti district. The launches served the important function of uniting key district officials around the importance of a concerted, strategic approach to HIV/AIDS and TB. By making these events both public and inclusive, AIM hopes to increase district-level ownership, commitment and responsibility for the plans and their implementation. 1.4 Phase II Districts Program Year 2 also saw the start of activities in the six Phase II districts. AIM awarded contracts to two groups from Makerere University to carry out the needs assessments in the Phase II districts. All data collection was completed during PY 2 and the final reports will be available early in PY 3. The DHACs were reactivated and they provided important assistance during the needs assessment exercises. By the end of the year the process of developing HIV/AIDS strategic plans had started and draft documents had been produced. In order not to delay the start of supporting services in the six districts, and benefiting from Phase I experiences, the capacity building activities in the six Phase II districts 6

13 were carried out concurrently with other activities relating directly to services. The six districts participated in many of the trainings conducted for Phase I districts and they were also encouraged to send proposals on HIV/AIDS services for AIM support. A total of 17 grants were awarded to the Phase II districts, predominantly in Mubende. 1.5 Security Issues and Work in Conflict Areas. The security situation in the North remained tense throughout PY 2. The Lords Resistance Army (LRA) continued to mount attacks on civilian targets with occasional skirmishes with government forces. Most of the Pader district civilian population continued to live in camps of displaced persons. Rebel activity also disrupted lives and activities in some parts of Lira and Apac districts. In the last quarter of PY2 rebels entered the districts of Katakwi and Soroti where they also caused massive displacement of people. New IDP camps have sprung up in Lira, Katakwi and Soroti. Kitgum and Pader have, for the most part of the year, remained largely no go areas for civilians and in August, 2002 the LRA gave an ultimatum to all NGOs and foreign agencies working in the North to quit the area. As a result of the security situation, the Needs Assessment exercise could not be conducted in Pader and in some sub-counties of Lira and Apac. For all district trainings conducted by AIM during the year, Pader district officials had to be drawn out of their parent district to another, safer district. During the year, it became apparent that there wasn t a significant number of organisations that could provide HIV/AIDS services in Pader district, and even for the few that were there it would be logistically difficult for AIM to monitor their activities if they were funded by the program given the difficulty of travelling to the district. It was therefore resolved to go into partnership with some national level organizations that had experience of working in conflict situations and that were in position to partner with local organisations in Pader. Two organizations identified were CRS and AVSI an MOU with CRS should be finalized in early PY 3. To support the clinical services, another MOU with the DDHS Pader is also being finalized. AIM s Communications and Information Coordinator C.Turyatemba answering questions on the programme s role in the conflict district of Katakwi. To respond to the new conflict situation in the districts of Katakwi and Soroti, AIM has identified some emergency HIV/AIDS interventions, derived from a proposal developed by the District Disaster Management Committee that will be supported. The activities have been discussed in detail with those organisations that the district has identified as the implementers and the MOUs will be completed in the first quarter of PY 3. Identified activities include providing VCT services for people in the camps, supporting BCC activities in the camps, infection control activities in the camps and providing care and support for PHAs. 7

14 Based on the experiences and discussions held with stakeholders in the conflict districts, AIM has written a draft document on emergency HIV/AIDS interventions in conflict situations that will be discussed with other stakeholders to help guide the program s future approach to supporting HIV/AIDS services in emergencies. AIM of course is not the only group affected by the security situation. In recognition of the need for a common focus and greater urgency around programs in conflict areas, USAID/REDSO convened a series of meetings to help develop and support a shared, strategic approach to working in conflict areas. AIM, along with UPHOLD and many other USAID-funded projects, is an active participant in this process. 8

15 Section 2: Activities and Achievements at National Level THE AIDS/HIV INTEGRATED MODEL DISTRICT PROGRAMME - UGANDA Although focused on district capacity building and support for services, AIM also engages at national level in support of its program objectives. National level interventions contribute in several important ways to the AIM program. These include: Policy development to inform program design and implementation Curriculum development to support training and capacity building Institutional strengthening among collaborating partners Support for decentralization Network development and mobilization of constituencies Development of quality standards and approaches for services AIM s work at national level during PY 2 is summed up below. 2.1 Joint Institutional Assessments (JIA) The JIA process that started in the previous year was completed and the reports of the assessment exercise for each partner NGO agreed and finalised. The results from the assessments were used to identify and design a series of capacity building workshops for the 10 participating national NGOs. The areas covered in the six workshops were Strategic Planning, Monitoring and Evaluation, Human Resources, Resource Acquisition, Budgeting and District Operations. The workshops, conducted monthly, were facilitated by a combination of consultants, AIM staff and World Education Boston staff. On average each workshop was attended by 19 to 20 participants from the 10 NGOs. Follow up technical assistance on the areas covered in the workshops was extended to the NGOs on request. Discussions were held with the 10 NGOs to identify how the NGOs could be supported to mobilize their district constituencies to develop proposals on HIV/AIDS service delivery for AIM funding. 2.2 Support to National TB Program At National level, AIM worked with NTLP to strengthen their capacity to provide program leadership. AIM assigned a full-time staff person to work with NTLP. AIM assisted the NTLP to establish a Local Area Network for internet connection in six offices, including the program manager s. Desktop and laptop computers were installed. This will make it possible to computerize the records and improve communication and transfer of information between the zones and districts. AIM further assisted NTLP with procurement of office equipment including two photocopiers and a fax machine. In addition, AIM sponsored one NTLP staff person for a six-week laboratory training course in the US. With the support of AIM, NTLP successfully organized two national TB stakeholders meetings the first to share 9

16 experiences and the second to discuss issues related to the central laboratory. Issues from these meetings included: Identification of constraints to program implementation Stakeholders were able to outline their activities in the TB control program Implementation of Urban CB DOTS is difficult and requires operational research The electronic register should be tried out but it should if possible include a Logistics Management Information System. A central training team should be trained to increase the pool of trainers for CB DOTS Quality Assurance of service delivery was found essential Support by AIM to renovate the Central TB laboratory was requested 2.3 Policy and Guideline Development VCT training manual Expanding access to VCT in the 16 districts is a priority goal of the AIM Programme. While simultaneously rolling out VCT grants to district service providers, AIM continued to work with key partners at national level to develop policy guidelines and training manuals. The draft VCT training manual that AIM has been supporting the MOH to develop was completed and displayed in the International HIV/AIDS conference in Barcelona. Comments from the manual were received from CDC and these were incorporated into the draft in preparation for field testing. The final draft manual is organised in a flexible and sequential format that is responsive to the training needs of both new and experienced counsellors in the field. The first two-week training course is tailored to the needs of new counsellors and covers all topics needed to train an HIV counsellor to offer VCT testing. In addition, the manual includes two one-week training courses with up to date information suitable for experienced counsellors who need a refresher course, and for new counsellors who have basic knowledge and experience but need additional related information and skills. In March 2003 the field testing of the draft VCT manual with MOH was carried out in Kampala. One AIM staff and one senior AIC trainer worked with MOH trainers to facilitate the training sessions. A total of 35 health workers from government facilities participated in the field test. VCT Manual field testing workshop at Tall Cottages, Mengo 10

17 VCT Policy Manual AIM, with support of USAID, provided technical and financial support to the MOH for the development of the Uganda National VCT Policy and the Uganda VCT implementation guidelines. The process took about eight months and involved meetings and workshops for core team members, technical experts and consensus meetings for stakeholders. Both documents are expected to be ready in first quarter of PY 3 for submission to MOH. Materials development for training in-service health delivery In an effort to ensure delivery of quality HIV/AIDS services, AIM has supported the development of several training materials. These include: i) the development of a training curriculum in comprehensive HIV/AIDS care, of which a second draft is now available; ii) the development of an opportunistic infection training manual for health workers. A second draft is now available and ready for pre-testing and use for training of a central training team; iii) finalization of various training manuals for PMTCT through financial and technical assistance to MoH; iv) support to MoH to review and edit the existing home based care training guidelines. Consensus on the contents of a home based care kit has been reached and the process of procuring these kits for PLWA has been initiated. District Guidelines for HIV/AIDS Coordination AIM has been involved with the UAC, MOLG and ULAA since May 2002 in developing national guidelines for district HIV/AIDS coordination. The guidelines bear significantly on AIM s work in the district in that they determine the structures at district level that AIM would work with to support HIV/AIDS services. In May 2002, AIM hosted the first meeting of HIV/AIDS stakeholders and district representatives in which issues of coordination at district level were discussed. AIM was part of the technical working group that drafted the coordination guidelines. AIM also supported financially the workshop in Soroti at which the guidelines were disseminated to the district Chairpersons and CAOs for their endorsement. AIM piloted the operationalization of the guidelines in the 16 districts by way of training the DATs and the DHACs and supporting the HIV/AIDS strategic planning process. AIM has continued to be a member of the working group and has helped provide feedback to UAC on experiences in using the guidelines. 11

18 Support for the Presidential Initiative on AIDS Strategy for Communication to Youth (PIASCY) In 2002, the President of Uganda directed all heads of educational institutions to initiate a campaign against HIV/AIDs in schools. The campaign brought together a multi-sectoral task team to develop a PIASCY handbook for use by teachers in schools to guide pupils on responsible sexuality and HIV-related risk behaviors. AIM was actively involved in providing TA to the PIASCY handbook. This presidential initiative was officially launched in May. AIM suggested to MOE and UAC that specific areas could be funded including teacher training, monitoring and evaluation and additional input from the ethics and health based groups. AIM ultimately provided funding support for these areas. 12

19 Section 3: Progress towards AIM Program Objectives AIM targets 10 core service areas in the fight against HIV/AIDS and TB. Progress in these service areas is described below, grouped within appropriate program objectives. 3.1 Objective 1: To strengthen the capacity of government and NGOs, CBOs, FBOs and the private sector to plan, implement and manage integrated services at national, district and sub-district level AIM s work in building capacity has been described in earlier sections (1 and 2) of this report. To recap, through the appropriate use of training, focused technical assistance and support, AIM helps build the human and institutional capacity of public, private and NGO organizations to deliver services. The M&E team at AIM works closely with district and national partners/grantees to develop M&E plans, monitor implementation of activities, capture and report on progress, and provide feedback to improve the quality of programs. 3.2 Objective 2: Increase integration and quality of comprehensive HIV/AIDS interventions at the district level IEC/BCC Many of the interventions that AIM supports will include, or indeed be driven by, a strong IEC/BCC component. The grantees that AIM supports do not, in general, have access to effective materials and they may not be aware of innovative approaches developed by others. Further, their capacity to develop, test and implement effective IEC/BCC interventions is often quite limited. As a result, behaviour change communication interventions are frequently of low quality and limited effectiveness. In recognition of these challenges, AIM contracted with the Communication for Development Foundation of Uganda (CDFU) to undertake a comprehensive review, at national and district level, of existing resources and capacity for IEC/BCC in the HIV/AIDS/TB arena. With organizational and logistics support from AIM, CDFU staff conducted interviews and collected data from 15 of AIM s 16 districts, visiting district officials and representatives of NGOs, CBOs, FBOs and others with IEC/BCC efforts related to HIV/AIDS. In addition, the data collection effort extended to national organizations, ministries, projects and donors. The report generated by CDFU will serve AIM and others as a useful inventory of resources and help identify important gaps that AIM may be able to focus on. When finalized, the CDFU report will be shared by AIM with a wide array of interested partners. 13

20 Referral Network for AIDS (RNA) During the year, the concept of a one-stop shop for HIV/AIDS services was further developed. Meetings were conducted with key stakeholders including DDHS, Health Unit staff, CDC, MOH, MOLG, USAID and selected FBOs to develop a system that would ensure availability of quality, integrated, HIV/AIDS and TB community and facility-based services through Private-Public-Partnerships (PPP). The following key issues emerged: 1) Facility-based services at lower health units are more likely to be integrated since one provider usually attends to multiple health needs of clients. Also, lower health unit services interface significantly with communities and provide an excellent opportunity for PPP. 2) It is practically difficult to have all the relevant HIV/AIDS services under one roof. Rather, service delivery points in communities and facilities offering quality services should be linked through a network that is supported by an active referral system, hence the name Referral Network for AIDS/HIV services (RNA). In this arrangement, integrated delivery of several related services may be achieved through thorough assessment of client needs, offering what one provider is skilled to do, and referring appropriately to other delivery points in the community and within facilities. The RNA mechanism as a tool for promoting PPP and increasing access to quality service-delivery will be operationalized on a selected basis in PY Objective 3: Increase access to and utilization of quality HIV/AIDS prevention services in selected districts and sub-districts VCT During the year, AIM conducted discussions with MOH, AIC and district officials from Apach and Lira on how VCT services could be supported and expanded in the North, particularly in the two districts. As part of the discussions and preparatory work, a joint assessment of potential VCT sites was carried out by AIC and AIM. A total of fifteen sites were assessed. At the end of the discussions it was agreed that the districts would offer personnel, premises and other operational support; AIC would provide capacity building and technical support; AIM would provide both technical support and funding, and; the MOH would spearhead as well as oversee the activities. It was agreed that AIC submit a proposal to AIM for funding VCT activities for the northern districts and this proposal has now been received and is under review by AIM. During the year AIM supported, through grants, a total of 26 sites that offer full VCT services including pre- and post-test counseling, testing services and other follow up services. In addition, AIM supported 23 sites that offer partial VCT services such as outreaches and counseling with referral for testing. 14

21 PMTCT In support of district efforts to initiate or expand PMTCT services, AIM gave technical assistance to at least two sites from ten districts to write comprehensive and integrated PMTCT proposals for review and funding by AIM. This formed part of an effort to support the establishment/strengthening of at least two PMTCT sites per district. By end of June 2003, 17 proposals on full PMTCT services had been received and an additional 10 were being expected. It is planned to fund most of these in the first quarter of PY 3. Also during the period AIM supported indirectly through its grantees a total of 12 PMTCT sites in the three districts of Bushenyi, Ntungamo and Rukungiri. Sexually Transmitted Infections (STI) AIM engaged in developmental STI activities in PY2. This involved technical meetings with partners with whom AIM will work to support districts deliver quality STI preventive and treatment services. AIM has supported the STD unit of the Ministry of Health to work out mechanisms to review and update the available training materials for STIs. This process will be completed in PY3. Through selected grantees, AIM has promoted the syndromic management of STDs in selected districts through training of health workers and support to the DDHS to conduct quality technical support supervision. Targeted Prevention Programs The district situational analyses and needs assessments for the nine Phase I districts identified risk populations for HIV/AIDS to be mainly internally displaced populations, long distance truck drivers, fishing populations, bar and hotel attendants, commercial sex workers and unemployed youths. District strategic plans extensively targeted these populations at risk and 52 proposals developed by relevant district partners were funded by AIM to provide targeted prevention services. Key activities supported included appropriate IEC programs (radio and drama), community mobilization through training of community leaders, condom education and promotion, use of sports to engage youths and to provide a forum for IEC/BCC discussions, use of peer influence techniques and life skills training. 15

22 Examples of organizations funded to provide TPP services are: THE AIDS/HIV INTEGRATED MODEL DISTRICT PROGRAMME - UGANDA Organization District Katakwi Probation Dept. Planning & Development Secretariat HealthNeed Uganda Community Vision Bushenyi District Human Resources Section Uganda Red Cross, Lira C.O.U Kisiizi Hospital HBC Ankole Cultural Dramactors Apac DHS Buseta Community AIDS Initiative Katakwi Kumi Soroti Tororo Bushenyi Lira Rukungiri Ntungamo Apac Pallisa During the year, meetings with partners at the national level, including CDC, Ministry of Gender, Labour & Social Development, MOH and UAC, indicated the need to target additional populations based on national epidemiological profiles. Examples of such populations are couples (concordant or discordant), girls years old and women. In PY3, AIM s organizational restructuring will significantly address the increased need for technical expertise in community HIV/AIDS response. Partnership support teams from the national, regional and district levels will work with partners involved in TPP to increase innovation and effectiveness of approaches to prevention of HIV/STIs in selected target populations. Condoms AIM has collaborated with partners in the development and implementation of a National condom distribution strategy spearheaded by MOH, a draft of which is now available. AIM has also conducted meetings with DELIVER and CMS to identify logistical problems associated with condom distribution in the districts. AIM s emphasis will be to support districts to implement this strategy and ensure that condoms are readily available to all the sexually active populations within the communities. AIM has supported selected grantees in the districts to identify logistical problems associated with condom distribution and has worked with them to scale up their efforts to increase the number of distribution points within the communities. 16

23 3.4 Objective 4: Increase access to and utilization of quality HIV/AIDS clinical, community and home based care in selected districts and sub-districts Management of Opportunistic Infections (OI) In the past 12 months, AIM has been working to ensure that more people can access quality OI services in the AIM districts and, moreover, within their communities. Comprehensive grants awarded to several DDHS include OI training for health workers and integrated technical support and supervision. A training curriculum in comprehensive HIV/AIDS care has been developed. This document will be distributed to all the districts and Health Units for service providers in PY3. AIM has supported the development of an opportunistic infection training manual for health workers that will be pre-tested in PY3. This will be used to enhance the capacity of district health workers to be able to offer quality OI services in AIM districts. AIM supported a one-month training of four medical officers in comprehensive care for HIV/AIDS at the Academic Alliance for AIDS Care and Prevention in Africa at Makerere University. These doctors will assist in conducting technical support supervision of OI services in their respective districts. Infection Control Activities Infection control activities contribute directly to improved quality of service delivery. In PY 2, AIM carried out assessment and training activities in a subset of its districts. This training will continue in PY 3 and will be integrated into other core service areas. Highlights from PY 2 include: Assessment of infection control has been conducted in conjunction with the MoH Infection control team. A comprehensive assessment addressing basic hygiene, waste disposal, sharps disposal, infection control practices in wards and sterilization was done in 19 health facilities in the four districts of Eastern Uganda and 11 health facilities in the three districts of Western region of Uganda. AIM collaborated with the MOH Infection Control team to carry out IC training. The training addressed basic hygiene, waste disposal, sharps disposal, infection control practices in wards and sterilization. Sixty-six people were trained from two districts of Western region (Rukungiri and Ntungamo). From the assessment, AIM developed an inventory of IC equipment and supplies. This inventory will guide AIM s procurement effort in PY 3 to ensure adequate IC equipment and supplies in all 16 districts Management of TB Activities As part of the extension of the Cooperative Agreement, extra funding was given for the TB component of the program. Part of the component was to work with the National TB and Leprosy Programme to establish or expand the CB-DOTS programme in the 16 AIM districts. To support the NTLP more effectively, AIM 17

24 seconded one specialist staff to sit within the NTLP offices and work closely with the NTLP staff. In addition, AIM successfully recruited a TB specialist who is stationed at the AIM headquarters and three regionally-based TB medical officers, all of whom were deployed in PY 2. AIM conducted an assessment of TB services in the districts of Kumi, Soroti, Katakwi and Bushenyi. The findings from the assessments were presented to the district health committees and teams and the district leaders were sensitized on the implementation of CB DOTS to solicit political support for TB activities. Training of community volunteers in Tororo district was done in conjunction with CDC. A total of 52 community volunteers were also trained in Kumi and Soroti, and 176 health workers in Katakwi, Kumi and Soroti completed their training on CB-DOTS. Supportive supervision of TB services has been conducted by AIM s regional TB medical officers in the districts of Tororo, Katakwi, Pallisa, Kumi, Soroti, Lira, Apac, Arua, Nebbi, Yumbe, Rukungiri and Mubende. In Katakwi, AIM supported the DTLS to attend a 4-week TB District Supervisors course at Buluba Leprosy Centre. Laboratory Capacity Building In PY 2, AIM provided support to districts to improve laboratory services. The support to the laboratories (HC IV and above) is aimed at improving their capacity to perform simple haematological tests, sputum analysis for TB diagnosis, blood smear for heamoparasites, serology for syphilis and HIV rapid serological tests. To further strengthen lab capacity, AIM procured laboratory equipment for labs in the Phase I districts from HC IV and above. The lab equipment will be delivered to the districts during the first quarter of PY 3. Training of professional laboratory staff from six of the Phase I districts was completed. In total, 70 lab staff from the districts of Apac, Lira, Katakwi, Kumi Soroti and Tororo participated in a training course conducted by AMREF. The training for staff from the other districts is slated for the first quarter of PY 3. To prepare for the refurbishment of laboratories, AIM carried out an infrastructural assessment for 82 laboratories. These included all laboratories (HC IV and above) in all 16 AIM districts. The assessment report was discussed with MOH and refurbishment is planned to commence in PY Objective 5: Increase access to and utilization of quality social support services for people infected and affected by HIV/AIDS including orphans, vulnerable children and adolescents in selected districts and sub-districts Support for People Living with HIV/AIDS (PHAs) During this period, AIM worked with national and district partners to develop mechanisms of reaching PHAs. Key national partners involved in discussions were PHA networks like NGEN+, NACWOLA, UNASO, TASO, and THETA. At the district 18

25 level, AIM held discussions with NGOs and CBOs like Teso AIDS Project (TAP), KASO (Kumi AIDS Support Organisation), LACAPI and others. District NGOs/FBOs/CBOs were awarded grants to provide services in support of PHAs. These included community sensitizations and mobilization, community and home-based care, management of opportunistic infections and STIs, condom education and OVC interventions. Unfortunately, such services were limited in most places because of a lack of organized PHA networks and because of the self-stigma that still exists in many places. To address some of these issues, AIM held discussions with national PHA networks to identify and support organizational development needs for scaling up programs for their constituencies in selected districts. In addition, AIM began discussions with NGEN+ that will lead to increased advocacy for PHA. A major example is AIM s planned support for an international PHA conference in October, BUDNET theatre artists depicting a scene of an HIV positive person s visit to a traditional healer. BUDNET women talk back session on challenges of being HIV+ women. Orphans and Vulnerable Children Granting was the primary means by which AIM provided support to the OVC core service area in PY 2. Over 40 district-based grants were awarded in 14 AIM districts, the majority of these going to Community Based Organizations. The following categories of activities were funded across the grantees: School-based HIV Prevention initiatives, including support for the establishment of Anti-AIDS Clubs in and out of school, training of child-peer educators, school HIV drama and education sessions, training of senior women and senior men teachers; Education, including support to formal and non-formal education through provision of scholastic materials, direct payment of school fees and provision of grants to schools for OVC education; 19

26 Psychosocial Support, including training of teachers, community volunteers, caregivers and youth in basic counseling skills for OVC; Socio-economic support and income generation, including support to establish income generating activities for OVC families and care-givers as well as training in IGA management; Community OVC initiatives, including community education and sensitization so that they can respond to OVC needs at community level, and community mobilization for support and participation in OVC initiatives; OVC care: Tracing and family/community reunification, resettlement of street children, support for repair of OVC houses especially the child-headed ones, food security through provision of ox-ploughs, improved seeds, goats, etc.; Advocacy/Policy Work: Participation in development of National OVC policy. Lessons Learned Although AIM has only recently started the grants program, some early lessons may be drawn from the type of grant proposals received. The majority of grantees focus on material support to OVCs; AIM will offer offer technical assistance to support more developmental-focused programming; As in other core services, AIM needs to improve the targeting and focusing of future grants to improve likely impact and geographic coverage; Much of what the grantees are implementing has been insufficiently guided by the District Strategic Plans and AIM s approach for OVC support. AIM will need to support districts to re-direct their OVC projects towards the OVC priorities identified in the Strategic Plans. Adolescent Services As with OVCs, AIM relied on the granting mechanism to support improved adolescent services during PY 2. Grantees in general did not differentiate between adolescent and OVC services, although increasingly AIM will. The following types of adolescent services are being funded by AIM through grants: In and out of school HIV prevention initiatives, including support of youth peereducators, drama and education sessions, formation of youth clubs and sports; Education, including vocational skills training; Psychosocial Support, including training of community volunteers, care-givers and youth in basic counseling skills for youth; Advocacy/Policy Work: Participation in development of National policy; Community HIV awareness, including support for establishing Community Youth Resource Centers. 20

27 Lessons Learned Based largely on the proposals reviewed and funded, as opposed to actual implementation experience, AIM has drawn some preliminary lessons: Need to target and support youth-led initiatives and associations towards prevention work as well as care and support; Need for much more focused solicitation backed by working closely with potential and existing grantees in conceiving, developing and implementing activities; Need to support districts and grantees to be guided more appropriately by both the District Strategic Plans and AIM strategy for adolescent services. Community and Home Based Care AIM undertook a number of activities in PY 2 in the area of Community and Home Based Care (CHBC). As described below, these include strategy development, the elaboration of training materials, and the award of grants to support CHBC initiatives. AIM developed a strategy for community and home based care that will be used by AIM to support national partners and district CBOs, NGOs and FBO s to implement CBHC activities. AIM supported a process of meetings that culminated in the development and review of a training guide for CHBC. AIM worked closely in this process with the Central Training Team and a number of NGOs, CBOs and FBOs implementing CBHC, including TASO and Nsambya home care and others. This is one of the documents that will be used by the districts, NGOs, CBOs, and FBOs in AIM-supported districts to improve the quality of care for persons infected and affected by HIV/AIDS. Community and Home Based Care interventions are supported by AIM through its grants program. Over 45 grants awarded to district entities include CHBC activities. AIM also played an active role, along with TASO, MOH, CDC and others, in establishing the necessary elements of a standard HBC kit, which AIM will begin procuring in PY 3. 21

28 Section 4: Grants Implementation 4.1 Strategy and Implementation Grants form the key strategy through which AIM supports service delivery in the districts. In PY 2 significant achievements were made in the grants program. With input from USAID and others, AIM drafted a grants strategy document that set forth an approach for grants management. This strategy clearly defines a process of increasing district-level responsibility for grants solicitation, review, award, and monitoring. Further, it clarifies that grants for service delivery will serve the strategic ends of fostering improved public-private partnerships while strengthening decentralized planning, co-ordination and decision-making. To support its grants initiative, AIM developed extensive tools, formats, protocols for field support visits, and documentation. The heightened emphasis on granting in the light of capacity building requirements for district initiatives also led AIM to reassign staff functions to support the grants program. In the second half of the program year, AIM started processing and awarding grants. By June 30 th 2003, a cumulative total of 81 grantees had received funding against a milestone target of 105. The breakdown is as follows: Level Location Nbr Grants Awarded Nbr Grants Funded Phase I Apac 1 1 Bushenyi Katakwi 8 4 Kumi 6 6 Lira 10 6 Ntungamo 4 3 Pader 2 0 Rukungiri Soroti 11 6 Tororo 9 6 Phase II Arua 2 0 Kibaale 1 0 Mubende Nebbi 5 0 Pallisa 3 2 Yumbe 0 0 National/Central Total The 81 approved grants actually understates somewhat the effort and achievement. The AIM grants team in fact processed 116 grants during the period. The reasons for the discrepancy are as follows: Grants receiving funding: 81, as above 22

29 Grants awaiting USAID approval (dollar value exceeds $25,000): 9 Grants awarded in the last two weeks of June and awaiting checks from AIM: 26 With support from consultants, AIM s capacity to review and process grants dramatically increased over the final quarter of PY 2. It is planned that the grants team will finalize all grants currently in the pipeline (about 40) while proceeding with a strategic solicitation of proposals planned for the first quarter of PY 3. AIM has conducted analyses of grants awarded by core service and district/subcounty ( gap analysis ) to guide this strategic solicitation phase. Regional and Headquarters teams provide regular supervision and support to grantees, and assist them with the quarterly reporting requirements. Data from the grantees are entered into the M&E database, which in turn is used by AIM to report against its indicators. The AIM district M&E manager, Mr. R. Nayenga discussing data entry and record keeping guidelines during a visit to a grantee in Tororo district. 4.2 Exceptional Cases: The vast majority of grants awarded by AIM support activities in the 16 districts, either directly or through central level institutions. Inevitably, a small number of requests for funding may reach AIM and receive funding even if they fall outside of the usual parameters for support. The larger of these exceptional cases are described below. The BIRO Project During the year AIM worked with AIC and TASO to support a Ugandan actor, Mwine Ntare, to stage his play Biro in two AIM districts Soroti and Ntungamo. AIM has used the play to undertake HIV/AIDS advocacy work in the 16 districts as well as build the capacity of district-based theater groups as a medium for communicating about HIV/AIDS. This has been done through training in BCC/IEC strategies using the BIRO approach. This approach helps people to use their personal experiences to develop their own local plays to mobilize and educate others on HIV prevention, care and support. The outputs from this project have included: 23

30 Staging the BIRO play in two districts; Training fifty artists drawn from district theater groups engaged in HIV/AIDS work using BCC/IEC; Development of a Training Module and Resource Books based on the BIRO theater principles; TOT for 15 Master Trainers based on the BIRO theater principles. These will be drawn from the districts and TASO/AIC headquarters; Pre-testing the Training Manual. AIDchild For several years, USAID has provided financial support to a U.S. NGO called AIDchild, which offers a full range of medical, educational and social services to HIV positive orphan children in Masaka. AIM received a grant proposal from AIDchild in PY 2 to extend this model of support to Mpigi district (not an AIM district). With USAID CTO and Contracts Officer approval, AIM awarded a three-year grant that allows AIDchild to: Provide a home and supportive family environment to 35 HIV positive orphans; Provide clinical services to the children it supports; Offer educational and vocational training to its children; Explore income generating activities to help sustain the AIDchild program. Children at the AIDChild center getting ready for an activity with their care givers. The grant to AIDchild falls outside the normal parameters for AIM support. AIDchild does not operate in any of AIM s 16 districts, nor does it qualify as a national partner. The size of the grant ($750,000 over three years)also separates AIDchild from the other AIM grantees. However, AIM hopes to learn from AIDchild s approaches and programs, and will look for innovative ways to share lessons learned with other organizations. AIM will also work with AIDchild to strengthen their linkages to the community so that children from the AIDchild program will one day be integrated into regular community structures and life. Support to World AIDS Day 24

31 AIM extended financial assistance to 14 of the AIM partner districts to support World AIDS Day activities. A total of US$ 11,500 was given to the districts directly while US$ 5,606 was paid to RiverSmith International for conducting a World AIDS Day concert in Soroti district. This concert was coordinated by UNAIDS. A range of activities was conducted during the district world AIDS day celebrations, including theatre productions, civic gatherings, public performances and discussion groups. RiverSmith International Theatre artists at the Voice of Teso studios during the World AIDS day activities

32 Section 5: Program Management and Planning 5.1 Planning for PY 3 THE AIDS/HIV INTEGRATED MODEL DISTRICT PROGRAMME - UGANDA Starting in April, AIM began to review the PY2 achievements and develop PY3 plans. Several meetings were organised with input from both USAID and CDC. The PY3 work plan will be submitted to USAID for approval in the first quarter of PY 3. The plan is organized around AIM s five program objectives, and fully reflects the shift in AIM focus from capacity building to support for service delivery at district level. The evolution of program focus and emphasis over the life of the AIM Program may be seen in the Annex Program Emphasis over Life of Project. AIM, UPHOLD and DELIVER recognize the importance of coordinated planning and implementation. A number of mechanisms were put in place during PY 2 to help ensure that each project reinforces, and learns from, the others. The three chiefs of party meet on a regular basis to discuss strategy and operational issues, while line managers have formed technical linkages around such issues as M&E, TB, and condom distribution. AIM and UPHOLD are co-located at Nakawa house, an arrangement that facilitates informal interaction as well as shared resources conference facilities and the resource center are prime examples. In the field, AIM and UPHOLD share offices in Lira. A concerted effort was initiated in PY 2 to standardize and harmonize administrative systems across projects in such areas as salaried, benefits, travel and per diem policy, etc. AIM looks forward to further collaboration and program synergies in PY 3 and beyond. 5.2 Monitoring and Evaluation and Quality Assurance AIM combines monitoring and evaluation and quality assurance in one unit. Until roughly the mid-point of the year, the unit was severely understaffed. With recruitment now largely complete, the unit is staffed to meet the challenges it faces. Staff added during the year included an Assistant Director, an M&E officer, a Data manager, a District M&E coordinator and a Quality Assurance officer. With the expansion of the AIM Cooperative Agreement came the need for a revised framework for monitoring and evaluation. After extensive discussion with USAID and CDC, AIM now has an approved Monitoring and Evaluation Framework that forms the backbone of its M&E efforts. The indicators in the framework serve the reporting needs of USAID and CDC in addition to AIM s own needs and interests. These indicators, in turn, underpinned the development of a comprehensive M&E database developed in PY 2. The M&E database was designed and completed during the year. AIM uses the database to capture and report on its primary activities, including training, technical assistance and the work carried out by the grantees. With the benefit of external consultant review and extensive use, AIM staff and consultants effected numerous modifications and improvements to the structure, content, and outputs of the database. The major changes included: 1. adding a unique identifier code for each grant for improved tracking; 2. enabling tracking of multiple concurrent grants to a single grantee; 26

33 3. greater precision in identifying type of grantee, particularly FBOs; 4. a listing of supplies and other items from non-aim sources. AIM M&E staff were instrumental in overseeing the needs assessment activities carried out in the 16 districts during PY 2. This involved developing terms of reference, going out for bids, approving data collection instruments, providing supervision and quality control, and standardizing the reports. The needs assessments are an invaluable tool for the DHACs, AIM and other partners as they develop both strategic and operational plans for HIV/AIDS services in the districts. Further, the assessments established baseline measures for many of AIM s indicators. AIM M&E staff supported the grants program by working with individual grantees to develop M&E plans for their proposed activities, and by training both grantees and district officials in M&E and in data collection and reporting. M&E staff spent considerable time in the districts working to improve the quality, timeliness, and completeness of reporting. AIM and UPHOLD M&E staff met on several occasions to discuss and plan for collaborative data collection efforts. UPHOLD is designing its baseline survey for health, education and HIV/AIDS. AIM has a residual need for baseline data related to its population-based behavioural indicators. It was agreed to explore a combined approach serving the joint needs of the two projects. The AIM situational analysis data collection tools, approach and lessons learned were shared with UPHOLD. An area of great importance and concern to AIM is how to capture service delivery data from the districts in a timely, routine, non-burdensome and nonredundant manner. Much of the work that AIM supports is not included in the HMIS of the MOH, and many of the service providers that AIM funds are outside of the public sector. Collectively, AIM-supported service providers use a variety of forms to report on the work that they do, in a largely inconsistent manner. AIM is working with its grantees to strengthen general data collection skills and to develop a culture of data use for improved decision making. The larger challenge for AIM is standardisation. As the number of AIM grantees steadily increases, ranging from large grants to the DDHS to small grants to CBOs, some degree of uniformity must be achieved in terms of the data collected. Grantees may already be reporting to multiple donors, and have expressed their concerns about yet another reporting requirement. Many grantees are also uncomfortable with the idea of reporting through the district structures. These are some of the many challenges that AIM will have to overcome. AIM staff and consultants spent considerable time in the districts learning about existing data collection and reporting efforts, and working with AIM grantees to help them meet AIM s reporting requirements. In PY 3, AIM plans to develop simple feedback mechanisms to facilitate data sharing, foster friendly competition among districts or grantees, and to guide local decision making related to HIV/AIDS service delivery. 27

34 5.3 Information, Communication and External Relations THE AIDS/HIV INTEGRATED MODEL DISTRICT PROGRAMME - UGANDA AIM staff developed numerous documents and presentations during PY 2 to help explain AIM approaches, objectives, and services to diverse audiences. These (primarily PowerPoint Presentations) served event- or audience-specific needs, while others were developed to reach a broader audience. With experience from implementation, AIM will begin documenting best practices and lessons learned and share them with appropriate audiences during the remainder of the program. In conjunction with UPHOLD, AIM has created a Resource Center that will meet the information needs of multiple audiences. SCOPE The AIM quarterly publication SCOPE continues to be in high demand from all districts and HIV/AIDS related agencies in Uganda. During PY 2, a total of three volumes of SCOPE were developed and disseminated. Each volume of SCOPE reaches an audience of about 3,000 readers, including district personnel, grantees, and national partners. AIM publications in the Resource Centre AIM Brochure The AIM Brochure was revised in PY 2 to reflect the changes in the AIM program. The brochure provides relevant information about AIM to a variety of interested parties in easily understood language. The brochure will be updated from time to time to reflect current programming and achievements. A one page briefing sheet on AIM was also developed and disseminated. Resource Center In collaboration with UPHOLD, AIM has developed a Resource Center that will increasingly meet the information needs of a variety of clients, including AIM staff, staff from other projects, students and researchers, government officials and district partners. A resource center assistant has been hired, and she will work with UPHOLD staff to further develop the center s capacity. The following are among the key achievements of the Resource Center: Completed AIM staff information user profiles to meet user needs; Regularly updated list of relevant websites shared with staff; Arranged subscriptions to leading journals, listserves, news update services; Drafted plans to provide information services to the districts and partners; 28

35 Resource Center staff will regularly update and circulate lists of holdings, services and resources throughout PY 3. In addition, AIM will establish resource centers in each of its three regional offices in PY 3. Susan (AIM) and Joseph (UPHOLD), resource centre staff Support to National AIDS Conference AIM sponsored 12 people to the National AIDS Conference which took place in Kampala in October, The participants were drawn from the 10 Phase I AIM districts, with each district represented by one person and one partner NGO (Healthneed) represented by two people. In addition, AIM made a presentation in the conference on strategic planning for HIV/AIDS and the integration of HIV/AIDS services. 5.4 Organizational Restructuring and Strengthening AIM engaged the consultancy services of Training Resources Group (TRG), a USbased firm which fielded a team consisting of two American and one Ugandan organizational development expert to conduct a review of AIM s organizational structure and staffing. The team s report has been used as a basis for extensive organizational restructuring. Key issues being addressed by the new structure are 1) strengthening the granting and partner support function, 2) improving management by creating a deputy director position, and; 3) strengthening the regional offices to provide continuous, stronger support to the districts. The next phase in the process will involve placement of existing staff into the new structure, filling the vacant positions, and developing systems to ensure that the different teams function effectively and in a coordinated and integrated manner. Staffing The staff team in AIM grew substantially during PY 2 as a result of the expansion of AIM from 10 to 16 districts, the heightened focus on TB management, and the change in organizational structure which directed greater human resources towards the districts. As PY 2 drew to a close, the AIM director resigned his post. 29

36 Recruitment for his replacement will be a top priority in early PY 3. Dr. Paul Waibale was appointed Acting COP on June 11, Office Move Due to the expansion of the program AIM shifted to more spacious offices in Nakawa House, Plot 3-7 Port Bell Road, Kampala. AIM moved into its new offices in January 2003 with minimal disruption to scheduled activities. The USAID-funded UPHOLD and SDU projects are also located in Nakawa House, facilitating meetings, discussions and collaboration. AIM s new offices in Nakawa House, Plot 3-7 Port Bell Road, Kampala 5.5 Finance and Administration AIM made a number of important improvements to its finance and administration systems. The division was reorganized and a flatter, organizational structure was put into place for a more efficient and clearer supervisory structure. New systems, with accompanying databases and training, were set up for the management of procurement, fixed assets and transport. AIM has precise plans in PY 3 for modification of the chart of accounts, establishment of accounting/budget links with the work plan, and improvements in human resources management in order to appropriately respond to the overall restructuring of AIM and the change of its priorities. As would be expected, expenditures increased significantly from PY1 to PY2, from $ 2.0 million to $5.7 million, an increase of over 185%. However, the last two quarters of PY2 (January to June 2003) in particular saw a dramatic rise in expenditure, averaging $ 2.3 million per quarter. The significant growth trend exemplified by these two quarters signaled a turning point in the program as AIM greatly expanded its program in the districts (grants, procurement and new regional staff) as well as the hiring of additional program staff to be based in Kampala. This trend will continue as we embark on PY 3. 30